Declaration of Consent and Waiver of Liability
We at Highlands Church look forward to serving you and your child through our “In His Image” Ministry Programs. Highlands Church seeks to provide a nurturing and safe environment for the care and training of your child during In His Image ministry programs. However, no matter how careful our staff and volunteers are, accidents can occur. To make certain that your child is participating in these activities with your full understanding and knowing consent, and informed parental guidance and instruction of your child, we ask that you carefully read and sign this form. If you have any questions about the program or policies, please contact Missy Farrington at 602-820-3345 or 480-342-7121.
In consideration for the services provided by Highlands Church through its In His Image Ministry programs, I agree to the following terms and conditions of my child’s participation.
Agreement to Participate and Waiver of Liability. To assist Highlands Church in providing the best care for my child during the In His Image Ministry programs, I agree to provide Highlands with accurate and complete medical information about my child, including all special medical, physical, mental and emotional needs or disabilities that my child may have, on the In His Image Ministry “Family Profile” and to immediately update such information as developments occur from time to time. I have read and agree to fully abide by the policies set forth in the In His Image Ministry “Family Policies and Procedures Handbook” (incorporated herein by reference)
I understand that risk of injury to my child inherent in a program whose participants consist of individuals with physical, mental or emotional disabilities, who may exhibit violent or impulsive behavior or suffer from epileptic seizures. During any of the In His Image Ministry activities and programs, including but not limited to Sunday School, Respite programs and family events, my child may engage with activities such as nature hikes, sports activities utilizing balls or other game equipment, contact with animals, amusement equipment rental and playground equipment, transportation on church vans for off site activities and outdoor activities resulting in exposure to natural and human made conditions, such as sharp rocks and glass, unfriendly creatures, and hot sun. I understand that, while few injuries actually occur, the possible injuries that may occur include, but are not limited to, bruises, cuts, scrapes, broken bones, choking, damage to the head, internal organs and all parts of the body, drowning, neck and spinal chord injuries, illness, contagious diseases, other serious injury or death and impairment to general health and well being.
To the extent permitted by law, I (we) assume all risks of injury to my child, including those caused by accidents or the acts of other participants. To the extent permitted by law, I (we) further agree to release Highlands Church, In His Image Ministry, and their staff, volunteers, directors, officers, and agents of all liability for injury or illness to my (our) child or for damage to my (our) child’s property arising during any In His Image program or event due to any cause except the gross negligence or willful misconduct of Highlands staff, volunteers, or agents.
Photograph Consent: I (we) give Highlands Church permission to use, without compensation, my (our) child’s name and/or picture in presentations, media releases, newsletters and marketing materials primarily for the purpose of promoting Highlands Church and its In His Image Ministry programs and services.
Both parents (or legal guardians) of each child must sign.
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Child’s name (use one form for each child)
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Parent or Guardian Signature date Parent or Guardian Signature date